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An influential government advisory group met on Tuesday to answer one of the most pressing questions of the coronavirus outbreak in the United States: Who should be on the front lines when the first vaccines become available?
The Advisory Committee on Immunization Practices was due to vote on a proposal that would prioritize health workers and patients in nursing homes.
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The two groups together represent about 23 million Americans out of a US population of about 330 million.
As the virtual meeting began, panel member Dr. Beth Bell of the University of Washington noted that on average one person dies from COVID-19 per minute in the United States at this time, “so I guess that we don’t act too early. “
Later this month, the Food and Drug Administration will consider approving two vaccines manufactured by Pfizer and Moderna. Current estimates predict that no more than 20 million doses of each vaccine will be available by the end of 2020. And each product requires two doses.
As a result, shots will be rationed in the early stages.
The advisory committee will meet again at some point to decide who should be next on the list. Among the possibilities: teachers, police, firefighters and workers in other essential areas such as food production and transport; old people; and people with underlying medical conditions.
Experts say the vaccine is unlikely to be widely available in the United States until spring.
The 15-member panel of external scientific experts, established in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always endorses them.
The recommendations are not binding, but for decades they have been widely followed by physicians, and they have determined the scope and funding of U.S. immunization programs.
Whether or not to follow the guidelines will be up to the state authorities. They will also be responsible for making other more detailed decisions if necessary – for example, whether to put emergency doctors and nurses ahead of other health workers if vaccine stocks are low.
The outbreak in the United States has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases exploding in recent weeks.
About 2 million people live in nursing homes and other long-term care facilities in the United States. These patients and the staff who care for them accounted for 6% of coronavirus cases in the country and 39% of deaths, according to CDC officials.
The number of healthcare workers covered by the committee’s recommendation would be approximately 21 million.
It is a broad category that includes medical personnel who care for – or come into contact with – patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health workers and paramedics. Depending on how state officials implement the group’s recommendations, it could also encompass janitorial staff, food service workers, and medical records clerks.
The government estimates that people working in healthcare account for 12 percent of Covid-19 cases in the United States, but only about 0.5 percent of deaths. Experts say keeping healthcare workers upright is imperative so they can administer vaccines and deal with the growing number of infected Americans.
For months, members of the vaccination panel had said they would not vote until the FDA approved a vaccine. This is standard procedure for the panel, with a few exceptions, such as during a flu epidemic in 2009. But late last week, the group suddenly scheduled an emergency meeting for Tuesday.
Committee chair Dr Jose Romero said the decision stemmed from a realization that states face a deadline on Friday to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee has decided to meet now to give advice to national and local authorities, he said.
But some panelists and other experts had also worried about comments from Trump administration officials who suggested different vaccine priorities.
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Then last week, US Secretary of Health and Human Services Alex Azar pointed out that ultimately governors will decide who in their states will receive the vaccines. Vice President Mike Pence echoed this point of view.
The comments have raised long-standing concerns during the Trump administration that vaccination decisions will be driven by political concerns rather than science.
Asked if Azar’s comment played a role in scheduling the meeting, Romero said; “We don’t live in a bubble. We know what he said. But that’s not the main reason it’s done.
Jason Schwartz, professor of health policy at the Yale School of Public Health, said it made sense for the group to take the unusual step of making their recommendation known first.
“Without that formal recommendation, it creates a vacuum from which states could go in all kinds of different directions,” said Schwartz, who is not on the panel.
Dr William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, who is also not on the group, agreed that the group’s decision to make recommendations ahead of the FDA meeting is unusual.
“As you can see, the cart is a bit ahead of the horses here as we don’t have an approved vaccine yet,” Schaffner said. “But ACIP is already considering who should get this vaccine, if any, and when it will be approved.”
HHS officials have said they will distribute initial doses to states based on population, and some states may not receive enough to cover all of their healthcare workers and nursing home residents.
As a result, governors may have to decide which healthcare workers or regions will get vaccinated first, Schwartz said.
“It’s up to states to determine the most granular details,” he said.
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